When Practice Makes Perfect
Cesarean section (CS) is one of the most commonly performed surgical procedures, accounting for 21% of all births globally, and, in many middle- and high-income countries, C-section incidence has been steadily increasing. As with all major surgical interventions, the competency of the surgical team is a critical determinant in maternal and neonatal outcomes. Errors in technique or delayed decision-making can result in life-threatening complications, including hemorrhage, organ injury, and neonatal asphyxia (1).
Simulation-based training has emerged as a transformative educational modality in obstetrics. By replicating CS scenarios in a controlled, risk-free environment, trainees and clinicians have the ability to develop and refine their surgical skills without exposing real patients to potential harm. Medical simulations also allow multidisciplinary teams to rehearse emergency responses. Operative Experience, Inc. (OEI) is a leader in medical simulations, and we offer a fully operative, hands-in-the-body Emergency C-Section Delivery Simulator that enables full transverse or vertical emergency CS.
Epidemiology and Pathology
The epidemiology of cesarean section has changed dramatically in recent decades, evolving from a procedure of last resort to one of the most commonly performed operations in the world. The World Health Organization (WHO) estimates that cesarean section rates exceed 21% of all births, but there is considerable variation across regions: in parts of Latin America and East Asia, cesarean section incidence may be as high as 50%, while incidence in sub-Saharan Africa and parts of South Asia is as low as 3%. In most high-income countries, cesarean section rates are typically between 25% and 35%, with maternal requests for cesarean section being a primary reason for the elevated incidence (2,3). Common reasons for electing C-Section despite having no medical indication include pain avoidance, fear of pelvic floor trauma, and the desire to schedule the delivery.
Despite being a relatively standardized procedure, C-section carries significant pathological risks that underscore the importance of technical proficiency and situational awareness. Intraoperative complications include life-threatening hemorrhage, abnormal placentation, or inadvertent injury to adjacent structures, including the bladder, ureter, and bowel.
Prior cesarean section is an important risk factor for complications in subsequent C-sections. Among the most serious is abnormal placentation, which represents a growing pathological challenge driven by the rising prevalence of uterine scars. Placenta accreta spectrum (PAS) disorder is associated with catastrophic hemorrhage and may necessitate emergency cesarean hysterectomy. PAS incidence has increased in parallel with C-section rates, occurring in approximately 1 in 500 pregnancies in high-income countries, with rates several-fold higher in women with multiple previous uterine scars (1,4).
The changing epidemiological and pathological landscape of pregnancies in high-income countries, with rates several-fold higher in women with multiple previous uterine scars (1,4).
The changing epidemiological and pathological landscape of CS has direct implications for the design of simulation curricula. As the complexity of the C-section patient population increases, the demands placed on surgical teams escalate correspondingly. Simulation programs must incorporate scenarios that address not only routine C-section techniques but also the management of hemorrhage, difficult anatomy, unexpected placental pathology, and perioperative complications (5).
C-section Simulators Improve Outcomes
The traditional surgical training apprenticeship paradigm of “see one, do one, teach one” is insufficient to meet the dynamic challenges associated with many modern surgical interventions. Incorporating simulations into training curricula gives residents a standardized, reproducible means of practicing difficult techniques and honing surgical skills, and a growing body of evidence links simulation-based training in obstetrics to reductions in adverse events (5-7).
C-section is frequently performed under emergency conditions, and clinicians must be prepared for fetal distress, placental abruption, cord prolapse, and other potentially life-threatening complications. These high-stakes scenarios require rapid, coordinated responses that can be rehearsed in a simulated environment. Multidisciplinary simulation drills have shown that teams that train together in simulated emergencies demonstrate improved performance during real events, including faster response times, more appropriate resource mobilization, and fewer critical communication failures (6).
OEI offers the world’s only complete and fully integrated simulation labor and delivery suite. Our high-fidelity Emergency C-Section Delivery Simulator accurately replicates delivery positions, including normal vaginal birth, breech birth, nuchal cord, prolapsed arm, and emergency cesarean-hysterectomy with active hemorrhaging. Our models also provide residents with hands-on training in the use of forceps and vacuum-assisted deliveries.
Conclusion
Cesarean section is a common surgical procedure, but its frequency belies a complex, dynamic process that may be associated with numerous complications. Cesarean section simulation models are an effective way to expose OB/GYN residents and surgical teams to complications without putting patients at risk. Benefits of simulation training go beyond individual skill development; mounting evidence suggests that incorporating simulation technology into an educational curriculum is linked to more competent clinicians and better patient outcomes.
OEI offers a full suite of labor and delivery simulators that represents a complete and integrated training solution for the entire labor and delivery continuum of care. Our fully operable and incredibly accurate simulators feature tactile anatomy and realistic blood and fluids, and are uniquely designed to provide learners with a high-adrenaline, real-world operative experience.
References:
1. Jauniaux E, Bartels HC, Nieto-Calvache AJ, Hussein AM. Evolution of modern cesarean delivery: historic perspective and new challenges. Am J Obstet Gynecol. 2026;233(6S):S557-S568. doi: 10.1016/j.ajog.2025.03.008. PMID: 41485841.
2. WHO Statement on Caesarean Section Rates. World Health Organization. April 2015. Accessed April 11, 2026. https://www.who.int/publications/i/item/WHO-RHR-15.02
3. Grantz KL, Zhang J. Analyzing the stagnation of cesarean delivery rates in the United States over the past 15 years. Am J Obstet Gynecol. 2026;234(4):865-878. doi: 10.1016/j.ajog.2025.09.037.
4. Chaillet N, Dubé E, Dumont A. Epidemiology of cesarean delivery: frequency, indications, related morbidity, and evidence-based strategies for optimal use. Am J Obstet Gynecol. 2026;233(6S):S581-S612. doi: 10.1016/j.ajog.2025.08.006.
5. Rajan G, Tang BN, Ganeshan M, Jeganathan T. Simulation training in cesarean delivery. Am J Obstet Gynecol. 2026;233(6S):S385-S403. doi: 10.1016/j.ajog.2025.07.025.
6. Frenn R, Heisler E, Chen G, Zoorob D. Improving resident comfort with peripartum cesarean hysterectomy through the use of low-fidelity simulation models. Cureus. 2024;16(9):e69056. doi: 10.7759/cureus.69056.
7. Weyers AR, von Waldenfels G, Gebert P, Henrich W, Hinkson L. Reducing trainee mistakes. Better performance with changing to a high-fidelity simulation system?. AJOG Glob Rep. 2024;4(2):100326. doi:10.1016/j.xagr.2024.100326.
